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        <p>第四节 修复前的治疗<br>1.OHI和清洁<br>2.是否配合正畸治疗。<br>a.缺牙间隙大小和分布<br>b.牙齿轴向位置是否调整<br>c.覆颌小于3mm可行<br>d.覆颌小于4-5mm考虑粘接面积和连接体<br>e.小开颌时可以在固定翼位置上建立前导<br>f.建议正畸结束后12周再考虑修复保持。<br>3.外科手术治疗<br>1）目的<br>a.暴露舌侧更大的釉质粘接面积。<br>b.软组织增量增加唇侧丰满度。<br>2）常用术式<br>a.翻转瓣技术<br>b.结缔组织移植技术<br>4.翻转瓣技术<br>1）适应症：高度足够，丰满度不足。<br>2）牙槽嵴顶切开，切到粘膜，将舌侧粘膜翻转到唇侧，缝合。<br>3）步骤：<br>①嵴顶切开软组织（表浅切口）<br>②翻开粘膜瓣（不做垂直切口）<br>③唇侧做垂直向松弛成粘膜袋<br>④粘膜袋要延伸至膜龈联合下方<br>⑤腭侧制备结缔组织瓣<br>⑥将结缔组织瓣翻折到唇侧粘膜袋。<br>⑦褥式缝合固定结缔组织瓣<br>⑧缝合嵴顶切口<br>⑨制作保持器压迫牙龈成形。<br>⑩10天拆线<br>⑪3周后牙龈形成凹陷制备印模<br>⑫试戴粘接<br>5.结缔组织移植技术<br>1）适应症：高度丰满度均不足<br>2）从上腭或上颌结节取结缔组织移植。<br>3）步骤<br>①切牙区牙槽嵴顶切口<br>②缺牙区牙槽嵴顶切口<br>③在上前磨牙腭侧或上颌结节处取结缔组织。<br>④区号的结缔组织放置于盐水中保持湿润。<br>⑤将结缔组织转移至唇侧制备好的粘膜袋内。<br>⑥根方水平褥式缝合固定结缔组织<br>⑦间断缝合嵴顶切口活动义齿轻压形成压痕。<br>⑧10-12天拆线。<br>⑨5个月后建议RBFDPS修复。<br>6.调颌治疗的适应症<br>1）前牙覆颌深覆盖无固位翼空间<br>①去模型上颌架评估<br>②在模型上调颌（模拟评估量）<br>③口内调颌（参考牙合架的）<br>④再次上牙合架确认<br>2）先天缺失导致对颌牙伸长无磨耗。<br>3）正畸治疗改变有限的情况。<br>第八部分 临床流程<br>第一节 全瓷与金属RBFDPS对比临床设计的独特性<br>1.不需要制备相互平行的固位沟<br>2.刚性大不变形<br>3.不需要特殊的平行测量仪<br>4.邻面需要考虑箱状洞型（连接体的强度）<br>5.舌隆突上钉洞要考虑引导就位<br>第二节 全瓷RBFDPS的临床步骤<br>预备前的准备<br>①术前面弓转移<br>②在诊断模型上制作蜡型(WAX-UP)<br>③硅胶翻制阴模口内树脂模拟（MOCK-UP）<br>④测试口内咬合接触点（动态和静态）<br>⑤制作预备导板<br>a.硬质硅橡胶重体<br>b.可以在石膏模型或口内制作<br>c.纵向导板及舌侧横向导板<br>⑥记号笔标记预备的边界（红色标记邻面边界蓝色标记预备区域）<br>⑦邻面预备<br>a.工具选择(8878-314-014)<br>b.车针平行于唇面转速2-4万转/分<br>c.打磨范围：标记线内<br>d.深度0.7mm<br>e.连接体高度至少3mm<br>⑧颈部浅凹预备<br>a.工具选择（8878-314-014）<br>b.边缘在CEJ冠方<br>c.龈上或平龈<br>d.宽度0.7mm<br>e.车针平行于唇面<br>⑨切端浅肩台<br>a.工具选择（8837KR-314-016）<br>b.避开咬合点<br>c.距龈缘2-3mm<br>d.深度0.7mm<br>⑩邻面箱状洞型<br>a.工具选择（8878-314-014）<br>b.长2mm宽2mm深0.5mm<br>c.方向：与舌唇向就位道一致。<br>d.交线角圆钝。<br>⑪舌隆突钉洞<br>a.工具选择（8801-314-018）2-4万/分<br>b.方向与就位道一致<br>c.整个直径进入<br>d.核对检查<br>⑫制备舌面固位翼空间<br>a.工具（8368-314-023）2-4万/分<br>b.空间与对颌空间0.7mm<br>c.不必嵌入牙体<br>d.整个预备都在釉质层<br>⑬抛光<br>a.工具选择：金刚石成分硅胶尖（1万转/分）<br>b.电马达控制转速<br>c.根据情况是否排龈<br>d.核对缺牙区的牙龈成形<br>e.印模前准备<br>⑭印模<br>a.材料选择：加成型硅胶<br>b.托盘：钢托盘或个性化托盘<br>c.方法：一次法<br>d.特氟龙交代球填补余牙倒凹<br>e.基牙涂布轻体吹匀托盘就位。<br>f.取模型的时候不要作用晃，垂直脱位。<br>第三节 临时修复体的制作<br>1.根据美学蜡型制作临时修复体<br>①美学蜡型翻制硅胶阴模<br>②灌制石膏模型<br>③压膜机压膜（类似保持器）<br>④缺牙区填塞树脂<br>第四节 医技沟通的注意事项<br>1.原始模型及制备后模型交给技师<br>2.面弓及颌位关系交给技师<br>3.技师设计CAD/CAM成形后给医师展示结构连接及厚度<br>4.医师确认数据（连接体高3mm宽2mm固位翼0.7mm不设计外展隙）<br>5.涉及软组织成形的案例建议试戴基底</p>
<p>总结：术前准备和临床步骤。 </p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的知乎文章地址： <a target="_blank" rel="noopener" href="https://www.zhihu.com/people/zhao-you-min/posts">https://www.zhihu.com/people/zhao-you-min/posts</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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